0
Sign In  | Subscribe
1 January 2008, Vol 148, No. 1>
Summaries for Patients | 1 January 2008

The Effect of Drug Concentration Expression on Epinephrine Dosing Errors FREE

[+] Article and Author Information

The summary below is from the full report titled “The Effect of Drug Concentration Expression on Epinephrine Dosing Errors. A Randomized Trial.” It is in the 1 January 2008 issue of Annals of Internal Medicine (volume 148, pages 11-14). The authors are D.W. Wheeler, J.J. Carter, L.J. Murray, B.A. Degnan, C.P. Dunling, R. Salvador, D.K. Menon, and A.K. Gupta.


Ann Intern Med. 2008;148(1):I-30. doi:10.7326/0003-4819-148-1-200801010-00001
Text Size: A A A

What is the problem and what is known about it so far?

Epinephrine (adrenaline) is sometimes the best treatment for life-threatening allergies. The drug is stored in salt water in glass ampules, which are broken open when the drug is needed. The amount of epinephrine contained in the ampule label is usually expressed as both a dose (1 mg of the drug per 1 mL of salt water) and a ratio (1 part drug for every 1000 parts of salt water). Doctors understand doses much better than ratios. A ratio requires doing arithmetic to figure out how much drug to give. Dose errors with epinephrine are common. Having to do arithmetic to figure out how much epinephrine to give a person in an emergency might lead to those errors and to delays in giving the drug.

Why did the researchers do this particular study?

To see whether expressing the amount of epinephrine as a ratio on ampule labels leads to mistakes and delays in giving the drug.

Who was studied?

28 doctors.

How was the study done?

The researchers programmed a medical mannequin to look like it was having a life-threatening allergic reaction. They gave the doctors ampules of epinephrine and told them to treat the emergency. One half of the doctors was randomly assigned to ampules with labels that had the epinephrine dose. The other half was randomly assigned to ampules with labels that had the amount of epinephrine expressed as a ratio. The researchers then measured the amount of drug the doctors gave and how long it took them to give it.

What did the researchers find?

All but 2 doctors whose ampules with labels that expressed the amount of epinephrine as a ratio overdosed their patients. Because they had to figure out how much drug to give, the doctors using ampules labeled with a ratio also took about 1.5 minutes longer to give it.

What were the limitations of the study?

The researchers simulated an emergency. The findings might be different if the doctors had to treat a real person. In reality, ampule labels have both doses and ratios, not one or the other.

What are the implications of the study?

The use of ratios to express epinephrine concentration may be a source of drug error. Patient safety might be improved by expressing drug concentrations exclusively as doses.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general jounals
BMJ 2010;341:c5893-c1494.

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy This Article

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Register Now for a free account
Advertisement

Related Content

Customize your page view by dragging & repositioning the boxes below.

Topic Collections
PubMed Articles
Epinephrine-reduced articaine solution (1:400,000) in paediatric dentistry: a multicentre non-interventional clinical trial.
European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry Issue date: 2013 Apr
Tumescent anaesthesia.
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland Issue date: 2013 Jan 31

Annals of Internal Medicine

Other Resources

Copyright © 2013 The American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Buy This Article

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Register Now for a free account
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)